Introduction to Ophthalmology

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Attitude Attendance Commitment to learn 2-week rotation Be prepared Practice Evaluation Need to see secretary after this!!

   

Anatomy Physiology History Examination

Adnexa

History


 

General health and systemic diseases: DM,HTN, connective tissue disease, drugs Past ocular history: surgeries, trauma, glasses, lasers, eye drops Profile of the patient Chief complaint

History


Abnormal appearance: -Lids -Redness -Discharge

Pain:
    

Foreign body sensation Itching & discomfort Deep severe pain Eye strain Headache

Disturbance of vision
Blurred vision Loss of vision Diplopia Photopsia and haloes Floaters Visual field

Discharge
Watery Mucoid Mucopurulent Secretion Vs drainage

Common problems


Sticky eye but clear vision - conjunctivitis

Painless progressive loss of vision in the aged - cataract

Pain, poor vision, rainbows around lights - angle closure glaucoma

Baby - one sided discharge, watery from birth NLD obst

Red eye, photophobia and blurred vision with or without pain, uveitis

No symptoms or vision of one eye found to be poor by chance chronic simple glaucoma

Sudden onset of horizontal diplopia especially in elderly - e.g. V1 cranial nerve palsy

Episodes of transient total visual loss in one eye - amaurosis fugax - retinal arterial emboli/carotid artery disease

Upper half of visual field went suddenly in one eye: arterial or venous obstruction

Dark curtain in front of one eye, coming from below; varies with head position - upper half retinal detachment

Examination


Visual Acuitiy
  

Central vision Macula Best corrected

Visual acuity tests in verbal children

At age 2 years (naming pictures)

Kay single picture

Multiple pictures

At age 3 years (matching tests)

Sheridan-Gardiner

Sonksen-Silver

External examination Lids Misalignment Redness Corneal opacity

Perkinje Sanson images

   

1st image: anterior corneal surface 2nd image: posterior corneal surface 3rd image: anterior lens surface 4th image: posterior lens surface, real, against movement

stains
 

Fluorescein stain Rose bengal

Pupils

  

Central, regular, reactive, round Direct Vs indirect Swinging light reflex, RAPD

Red reflex

Eye drops


 

Anticholinergic: Tropicamide, cyclopentolate, atropine. Adrenergic agonists: phenylephrine, adrenaline Topical anesthetic cycloplegia

 

Extraocular motility Muscle balance

Visual fileds
 

Confrontation Perimetry

Ophthalmoscopy
     

Direct ophthalmoscope Dialated pupils NB angle closure Disc: cup/colour/contour Macula Blood vessels Periphery

Invistigations
    

FFA Perimetry Ultrasound CT MRI

FFA

CT scan

Visual field

Ultrasound

MRI

Thank you
Dr. Hasan Mohidat Chief resident, Ophthalmology, KAUH